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APPLICATION FOR SANITATION PERMIT Permit No. �.. A. (Complete in Duplicate) r ,"` G ((Pry_:-•7� 7r ;�Sa..Jci Date Issued ----__-_ ' ` 4&�2— 042—Z,6 i Application is hereby made,to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION_y----- T v f N AteJ6_-AJ -- ---- ----------------------------- Zj 0wneris' NaFrrie-__--� , �- ----- 1E3 c i �,�y - --- ---- -- - ----j---------- - - - ------ ... Phone-�- --�-7 Address---- ------ 1 - 1 u / i�! --- -------•-s------------------------------------------------------ --------------------------••-------- Contractor's Name--------- --_�'�- = --------------------f------------------------------------ .------ Phone Installation will serve: Residence ❑ -Apartment'House ❑ Commercial ❑ Trailer Court ❑ `Motel ❑ Other Number of living units: I--- Number of bedrooms ._ --. Number,of baths ---/__ Lot size -_-_-(--�' ---L-- r ---------------------•- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 4 ft. Character of soil to a depth of 3 feet: San ❑ Gravel ❑ Sandy Loam 0 Clay Loam � � d �Clay ❑ Adobe ❑ _Hardpan ❑ �,, Previous Application Made: Yes ❑ No [ New Construction: Yes E3. No ❑ FHA/VA, Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 0 � r r Septic Tank: Distance from nearest weft---c50_ --Distan f fr r� four* ation--_-__�a-__--.Ma trial_--aAIG,eE - ' No. of cgmpartments =-= .Sil � __x-----•------Liquid dep --- p tY Disposal Field: Distance from nearest well__ r -__--.__.Distance from founds#iop�-_-_��__--------Distance to nearest ladline ----------------- Type ---------------- �-- y f Number of lines_'----,�--'_----- ------------Length of each line__--- -O__--__j�---_----Width of trench----c7�-------------_--_ T e of filter materia-------------- -------- Yp � - Depth of filter material3�:___ r P 1 Total length gQ - ----- -- Seepage Pit: Distance to nearest well--_4.-----------------Distance-#rom foundation... to nearest lot line-___--___------_ `. .. ❑ Number of pits ----------- -------Lining material---------- -----------.Size: Diameter----------------- Depth----------------- --------------- Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material---------------------------❑ Size:jDiameter-----------------•------ -------------Der` W----------------------- :--------------------------Liquid Capacity- -- -----gals. I Privy: Distance from nearest well------------ ------------------------------------Distance from nearest building ❑ Distance to nearest lot line------ ----------------------- - -------------_-_ ---------- Remodeling and/or repairing (describe): ---------//1r�3f} _ Q 7 �,� .' PQM —70 -------- -------- �SvfPv �----- Dv %�1U�r<- 1�r~P9'7f? Nl ----- --------------------------------- ------------- -------------------------------------------------------------------- ----------------------------------------------------------------=---------------------------------------------------------*----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance withSan Joaquin County ordinances, State laws, and rules and regulations-"of'th San Jbaquin Local Health District. Si ned � � r ` ------------------------------------ ------- { w n / r Contract By:----------------------•----------------------- --------------- ----------Tr+le --_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE"ONLY ' APPLICATION ACCEPTED BY °` DATE---------- ,- VIEWED BY --------- -.-- i!:? ----------- -- DATE i - - ----------- -- ----- --------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- -- --------. DATE--------------------- Alterations and/or recommendations:--.-_--------- ----_-_ ----------------------------------------------------------------------- ------------------------------------------ FINAL INSPECTION BY:---- --- ----------- Dafe------- i 4� SAN JOAQUIN LOCAL HEALTH,DISTRICT ' 130 South American Streat 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revsea 1.57 F.P.CO. S